Dilatation and curettage (D&C) is a minor surgical procedure to remove tissue from the endometrium (lining of the womb).
It is carried out by a gynaecologist (a specialist in treating conditions of the female reproductive system), and takes about 10 minutes.
D&C is not carried out as frequently as it used to be, partly because there are now better non-invasive diagnostic techniques available, such as ultrasound.
When it is needed
D&C is sometimes used to help diagnose a condition, such as polyps (a growth of cells) or cancer of the womb.
It can also be used for treatment purposes – for example, to remove polyps from the womb.
Read more about the conditions D&C can diagnose or treat.
D&C is usually carried out under general anaesthetic. There are two parts to the D&C procedure:
- dilatation – the cervix (neck of the womb) is widened
- curettage – the endometrium (lining of the womb) is removed using a scraping instrument
D&C is often used in combination with a hysteroscopy. A hysteroscopy is a procedure that uses a narrow telescopic device (a hysteroscope) to look inside the womb. The hysteroscope is inserted into the womb, allowing the gynaecologist to check for any abnormalities, such as polyps.
Read more about how D&C is carried out.
After the D&C, you will need to arrange for a friend, partner or relative to take you home and stay with you for 24 hours. You should be able to return to work within two to three days. Read more about recovering from a D&C.
D&C is usually a safe and simple procedure, and associated complications are rare. Possible complications could include:
- infection of the womb
- heavy bleeding
- Asherman's syndrome, where the womb is damaged, resulting in scarring
Read more about the possible complications of D&C.
Dilatation and curettage (D&C) is usually a safe and simple procedure, and associated complications are rare.
Possible complications are outlined below.
Despite the best efforts of medical staff, infection is always a risk after a surgical procedure. However, the risk of an infection developing following D&C is low.
Symptoms of a post-operative infection may include:
- a high temperature (fever) of 38C (100.4F) or above
- tummy pain
- a foul-smelling vaginal discharge
Seek medical attention if you experience any of these symptoms. Most infections can be cured with antibiotics.
Heavy bleeding is a rare complication of D&C. It can occur if a surgical instrument injures the wall of the womb, or if an undetected fibroid (a non-cancerous growth) is cut during the procedure.
As with infection, the risk of an instrument injuring the wall of the womb is low. Contact hospital staff if bleeding after the operation remains heavy and does not reduce over the course of the first week.
Asherman's syndrome occurs when D&C causes damage to the womb, resulting in scarring. If the scarring is particularly bad, it may then fill the womb and disrupt your periods. In some cases, it may cause infertility.
The Royal College of Obstetricians and Gynaecologists estimates that Asherman's syndrome occurs in less than 2% of D&C cases.
Asherman’s syndrome can usually be successfully treated by surgically removing the scar tissue.
Sometimes, Asherman's syndrome can be missed as a cause of infertility. If you are experiencing fertility problems and you have previously had D&C, discuss the possibility that you may have the condition with your doctor or gynaecologist.
How is it performed
In most cases, dilatation and curettage (D&C) is performed on an outpatient basis, which means you should not have to stay in hospital overnight.
D&C is usually carried out under general anaesthetic, which means you will be asleep and will not feel any pain or discomfort. However, if preferred, the procedure can also be performed using a local anaesthetic, where the area will be completely numb so you will not feel any pain or discomfort, but you will be awake.
Before having D&C, you will not be able to eat or drink anything for several hours. This will reduce your risk of vomiting or regurgitating food while you are under anaesthetic.
D&C usually takes about 10 minutes. The operation is performed through the vagina and it will not leave a scar. The cervix (neck of the womb) is widened using rods, and a small scraping instrument called a curette is passed into the womb to gently scrape off the womb lining (endometrium).
If the D&C procedure is being carried out for diagnostic purposes, the removed tissue sample (biopsy) will be sent to a laboratory to be tested.
D&C is being used less frequently to treat conditions such as heavy menstrual bleeding because newer techniques are now available that are more effective and/or less invasive.
One such procedure is known as endometrial ablation and involves a small probe being inserted through the cervix into the womb, after which lasers or microwaves are used to remove the womb lining.
However, endometrial ablation is not suitable for all women, such as those who have an irregularly shaped womb and those who have had previous womb surgery. In such cases, D&C may be recommended.
Why is it necessary
Dilatation and curettage (D&C) can be used to diagnose and treat a number of different conditions.
When D&C is used to help diagnose a condition, a tissue sample (biopsy) may be taken for testing in a laboratory. This diagnostic approach may used if you have:
- abnormal bleeding
- irregular periods
- spotting (a slight loss of blood through the vagina that does not relate to menstruation)
- bleeding after sex
- bleeding after the menopause
- fertility problems
- adenomyosis (where the inner lining of the womb grows inside the middle layer, causing pain, cramps and bleeding)
The sample that is taken from the womb will be sent to a laboratory to check for:
- cancer of the womb (uterus)
- polyps (abnormal cell growth)
- pre-cancerous cells
- cancer of the womb lining
D&C is sometimes used to treat the following conditions:
- excessive bleeding following birth - by clearing out any placenta left in the womb
- removing a molar pregnancy (an abnormal growth of cells inside the womb)
- removing polyps from the womb
- removing an intrauterine device (IUD) that has become embedded in the wall of the womb
- removing any tissue that remains after a miscarriage or abortion, to prevent infection
After the dilatation and curettage (D&C) procedure, arrange for a friend, partner or relative to take you home and stay with you for 24 hours because you may still be feeling disorientated due to the effects of the general anaesthetic.
Do not drive or operate heavy machinery for 24 hours after having the procedure. You should be able to return to work and normal activities within two to three days.
There are a number of important issues that you need to be aware of when recovering from a D&C procedure, which are discussed below.
Immediately after having D&C, most women will experience cramps that are similar to menstrual cramps. However, they should stop around 24 hours after having the procedure.
Mild painkillers such as paracetamol or ibuprofen can help to relieve any discomfort.
You may feel sick after having a D&C procedure. However, this should only last for a few hours.
After the procedure, it is likely you will experience some vaginal bleeding, which appears bright red at first, before fading to a brown stain.
Use sanitary towels rather than tampons to stem the bleeding, and avoid using tampons until your next period because this reduces the risk of developing an infection.
The bleeding should pass within 5–10 days of having the procedure. During this time, to avoid developing an infection, do not use any scented bath products or go swimming.
After you have had D&C, you should not have sex for several weeks. Exactly how long you will need to avoid having sex will depend on your individual circumstances, as well as the reason why the procedure was carried out. Your doctor will be able to give you more advice about this, although on average it is around 10–14 days.
If you had D&C to help diagnose a condition, the laboratory test results should be available within 14 days. Written confirmation of the results will be sent to you, or you will be given an appointment so you can discuss the results with your gynaecologist.
When to seek medical advice
You should seek immediate medical advice if you experience:
- excessive bleeding – prolonged heavy bleeding that lasts for over seven days and is bright red, has large clots and does not reduce and stop
- excessive pain – see your doctor if you experience anything more than mild discomfort
- signs of infection – if you have an unpleasant smell in your discharge, or a high temperature of 38C (100.4F) or above, it may be a sign you have an infection